Regardless of how long you've been practicing, you have undoubtedly come across a patient that has unrealistic expectations for surgery. This typically manifests in an unhappy post-operative patient. The patient may complain that their scar is too big, their recovery is taking too long, they are not able to return to work when they want, they cannot return to sports activities as quickly as they would like, they can’t wear stilettos, and the list goes on. And as we all know, an unhappy patient is more likely to file a lawsuit than a happy patient.

As you could probably surmise, amputations are a leading factor in malpractice suits against podiatrists. So, how do you reduce the risk that a complication will result in amputation? And if amputation is necessary, how can you reduce the risk of a lawsuit being filed?

As a practitioner, you have most likely experienced an unexpected outcome in your care and treatment of a patient. It does not mean you are a bad physician. It happens even with the most experienced physician, but it can be very distressing for you and your patient. How can you protect yourself from risk and maintain a healthy physician-patient relationship in the event of an unexpected outcome?

Start at the Beginning
First, prepare your patients for the possibility of an unexpected outcome. At the beginning when you’re developing a treatment or surgical plan with your patient, discuss the risks and benefits of your plan, including the most likely complications or side effects. Include a discussion of any risk factors that the patient may have that might affect the success of your plan. For example, a patient would be more likely to experience post-operative complications if they are a smoker. With medically complex patients, discuss the treatment challenges and the fact that they may require treatment from a team of specialists/healthcare professionals.

We continue to receive questions from podiatry practices regarding the use of and billing for amniotic fluid injections for musculoskeletal purposes. We recently published an article, “Caveat Emptor Vendor: Skin Substitutes & Injectable Amniotic Fluid” that details some real-life examples of the risk providers incur if they fail to do proper due diligence in these situations. In the article below, we continue the conversation around amniotic fluid injections by answering three of the most asked questions so you can make informed decisions at your practice.

In the past year, we have seen a dramatic uptick in audits and overpayment claw backs involving two high-dollar products: skin substitutes for wound care and injectable amniotic fluid used for musculoskeletal conditions. While there is no question that these products work, practitioners are often guilty of listening uncritically to sales pitches by vendors who promise high reimbursement and certain payer coverage. Failure to conduct due diligence on these products puts providers at high financial risk because of the substantial cash outlay required to purchase the products, typically upfront.

It is not uncommon for a podiatric physician to be named in a lawsuit when a patient suffers a DVT/PE following podiatric surgery or treatment requiring immobilization. Allegations against the physician commonly include:

All physicians know a medical record must be maintained on each patient. Why? Medical record documentation is required by state and federal laws. Proper documentation is important for continuity of patient care and necessary to receive reimbursement for services rendered. The patient’s medical record is a legal record of the care you provide to the patient and is a valuable tool in your defense should a medical malpractice lawsuit be brought against you.

If you’re thinking about retirement, it’s prudent to start planning well in advance. If you are a solo practitioner, will you sell or wind down your practice? If you are in a group practice or employed, what are your obligations regarding providing notice of retirement? What are your state licensing board’s requirements regarding retirement? How will you retain your medical and business records? How will you notify your staff and patients of your plan to retire? What do your contracts with health insurers require when you retire from practice? Do you need to purchase professional liability insurance “tail coverage”? 

Introduction to Integrative Medicine
Integrative medicine is an approach to wellness that is growing in popularity in the United States. It is patient-centered and combines conventional medicine and complementary medicine to treat the person as a whole. It addresses many factors, including the physical, emotional, social, spiritual, and environmental influences on a person’s health status. Integrative medicine focuses on the broader concepts of health that promote a person’s overall health and future well-being. Reviews and clinical studies have shown positive outcomes for patients and providers who participate in integrative medicine programs.

Background: Big Changes from 2021
The Evaluation and Management (E/M) codes have been based on the 1995 and 1997 E/M Guidelines for what seemed like forever. The E/M codes were based upon three key components: 1) the history, 2) the examination, and 3) medical decision making all performed at the proper levels. On January 1, 2021, everything changed. The changes were specific to Evaluation and Management services that were performed in the office or other outpatient places of service only. Clinicians are now able to use either time or medical decision making to select an E/M code. There is no required level of history or examination for the E/M codes.

Now: Highlights for 2023
On January 1, 2023, the changes that were made to E/M services that were performed in the office or other outpatient places of service were expanded to the other places of service. The E/M codes include a medically appropriate history and/or examination, when performed. The nature and extent of the history and/or physical examination are determined by the treating physician or other qualified health care professional reporting the service. The care team may collect information, and the patient or the patient caregiver may supply information directly (e.g., by electronic health record HERR) portal or questionnaire that is reviewed by the reporting physician or other qualified health care professional. The extent of history and physical examination is not an element in the selection of the level of these E/M codes.

Time is defined as total time spent, including non-face-to-face work done on that day and no longer requires time to be dominated by counseling. It includes time regardless of the location of the physician or other qualified health care professional (e.g., whether on or off the inpatient unit or in or out of the outpatient office). It does not include time spent in the performance of other separately reported service(s).

The definitions of medical decision making (MDM) are the same as the definitions of medical decision making that went into effect for office and other outpatient places of service on January 1, 2021.